LGBTI health in the ACT
What is LGBTI?
LGBTI is a common acronym standing for Lesbian, Gay, Bisexual, Transgender and Intersex. These are terms which describe sexual orientation, gender identity and sex variation. It is important to recognise that this acronym does not cover all forms of diversity. It is not intended to be limiting.
Lesbians are women who are romantically, emotionally, physically and sexually attracted to other women.
Gay men are men who are romantically, emotionally, physically and sexually attracted to other men.
Bisexuals are people of any gender who may be romantically, emotionally, physically and sexually attracted to more than one sex/gender.
Transgender people are people whose gender identity and/or gender expression differs to their sex assigned at birth. Transgender individuals may identify their gender as female, male, both or neither.
Intersex is an umbrella term for people who are born with atypical sex characteristicsi. Sex characteristics include: chromosomes, genes, external genitalia, internal reproductive organs, hormones, and secondary characteristics (like body hair)ii.
It is important to be clear on the differences between sex variation, gender identity and sexual orientation:
- Sex variation is the biological variation of sex characteristics that exist across the population.
- Gender identity is each person’s sense of self including their appearance, mannerisms or other gender-related characteristics.
- Sexual orientation is an individual’s dominant romantic, emotional, physical and sexual attraction towards persons of the same sex, persons of a different sex, persons of any sex, or persons of neither sex.
A person’s gender identity and sexual orientation can be fluid, and subject to change over time. A person may have different gender presentations for different situations. In a healthcare setting, it is important for healthcare professionals to respectfully find out the name, gender identity and gender pronouns of each person receiving care, to ensure they are correctly addressing them and meeting their core needs.
More detailed definitions and terminology are provided in an ACT Government glossary here: http://www.cmd.act.gov.au/__data/assets/pdf_file/0019/781120/Resource-4_LGBTI-Glossary.pdf
A diverse ACT
The ACT is enriched by the presence and contribution of its Aboriginal and Torres Strait Islander residents, together with a large number of cultural and linguistic communities, as well as people with disability, and people with a range of sexes, gender identities and sexual orientations. Canberrans come from over 200 different countries. LGBTI people come from all backgrounds and possess many varying abilities.
The following are some rough estimates of the demographics of the range of sex variations, gender identities and sexual orientations in the ACT:
About 1.7% of the population have an intersex variation.iiiWith an ACT population of 393,000 people (as of 2015), this would suggest that there could be approximately 6680 people in the ACT with an intersex variation. In 2014, there were 5552 babies born in the ACT,ivapproximately 95 of these may have an intersex variation. However, they will not all be identified as such at birth.
About 8.4% of the Australian population could be defined as gender diverse.vAbout 0.3% of the population have undertaken some form of gender transition.viUsing the 2015 population of the ACT, suggests that approximately 33012 people in the ACT could be gender diverse and 1179 people may have undertaken transition processes.
On sexual orientations, evidence suggests: vii
- Between 1% and 2% of the Australian population identify as gay or lesbian.
- Up to 15% of Australians have experienced same sex attraction or had sexual contact with someone of the same sex.
- 0.9% of men and 1.4% of women identify as bisexual.
Applying these percentages to the ACT population suggests that approximately: 7860 people in the ACT identify as lesbian or gay, 3540 men identify as bisexual, and 5500 women identify as bisexual. This mean about 16,900 people have a sexual orientation other than heterosexual.
The health of LGBTI people
The Australian Human Rights Commission has reported:
‘the burden of ill-health is not distributed equally across the [sex, gender and sexuality] spectrum[s]. For example, successive studies in Australia have demonstrated poorer health outcomes experienced by bisexual people compared to lesbian and gay people. These include higher levels of documented anxiety and depression.’viii
‘LGBTI Australians report lower health outcomes in the areas of cancer, [...] and cardio vascular disease, and from health impacting behaviours such as alcohol and tobacco consumption and illicit substance use.ix
The main health issues and discrepancies for LGBTI people may arise through stigma, stereotyping, discrimination, harassment and exclusion. This includes reluctance to access health care and support due to a fear of not being understood and supported by medical professionals. This difference includes health impacts that result from mechanisms for coping with that discrimination and harassment, for example using alcohol and other drugs as self medication.
Some health issues arise due to the more risky practices engaged in by some members of particular groups. For example, gay men and men who have sex with men engaging in unprotected sex, particularly anal sex, are more likely to contract and spread HIV and sexually transmitted infections. x Various methods can be used to ameliorate this difference through targeted prevention and interventions which support members of particular communities. This includes education about safer sex practices, rapid testing for HIV, pre exposure prophylaxis, post exposure prophylaxis, and early treatment of the infection. Targeted campaigns and improvement in treatments has lead to Australia having very few reported cases of AIDS, and the ‘epidemic’ of AIDS has been ‘stopped’.xi However, high rates of HIV infection continue in Australia. An example of targeted services in the ACT, is the M Clinic run by the Canberra Sexual Health Centre, which ‘is a free walk-in clinic at Canberra Sexual Health Centre offering Sexually Transmitted Infection (STI) checks for men who have sex with men, at a more convenient time’.xii
- Gay, lesbian, bisexual and transgender people are three times more likely to experience depression compared to the broader population;xiii
- At least 36% of transgender people and 24% of gay, lesbian and bisexual people currently meet the criteria for experiencing a major depressive episode, compared with 6.8% of the general population;xivand
- Transgender suicide rates have been estimated to be as high as 50%.xv
- Intersex people may have ongoing health impacts associated with medical interventions.
- For example, cosmetic surgery may have been performed which can result in lack of sensation, loss of reproductive capacity, hormonal imbalances, and mental ill health.
- Some people with intersex variations will require ongoing healthcare and support throughout their life associated with conditions that are more prevalent amongst people with certain intersex variations.
- Conditions linked to intersex variations include osteoarthritis, osteoporosis, obesity, heart problems, and in smaller numbers, kidney issues, scoliosis or chronic eczema.xvi
- These can be from the variation itself (such as Turner’s syndrome) or from interventions to address characteristics of the variation (such as hormone therapy). xvii
- Specialists in these conditions include paediatricians, endocrinologists, plastic surgeons, cardiologists, nutritionists, dieticians, dermatologists, and rheumatologists.
- Transgender people who want to use medical supports to transition, need access to a range of health practitioners including general practitioners, endocrinologists, psychologists, psychiatrists, and plastic surgeons.xviii
- Individuals may choose between particular practitioners depending on their own goals for transition.
- Unfortunately the self reported general health of transgender people has decreased between surveys in 2006 and 2012.xix
Lesbians and women who have sex with women can experience the effects of discrimination and misinformation from medical professionals. In particular, there is a myth that lesbian women do not need to have pap smears.xx This is not the case, and can place lesbian women at risk of cervical cancer not being detected early. As found in the Resilient Individuals report: xxi
‘[s]ocial and health research reveals that as a result of unconscious bias, lesbian women’s health has been largely ignored and, at best, considered synonymous with ‘women’s health’. [...] This [has] meant that research funding, practitioner specialisation and service provision has been less attentive to lesbian women.'
- Health practitioners are more likely to assume that a bisexual person is either exclusively heterosexual or homosexual.
- Bisexual people are less likely to disclose their sexual orientation to health practitioners. As a result, bisexual people are less likely to receive the screening, and healthcare supports that other people in either of these groups might receive.